BackgroundSWEMWBS is a popular measure of mental wellbeing, shown to be valid in clinical populations. Responsiveness to change has not yet been formally assessed.MethodsAnalysis of data from a clinical sample of 172 clients undergoing up to 4 sessions of cognitive hypnotherapy. Cohen’s D effect size (ES), Standardised response mean (SRM), probability of change statistic (P^) were used to evaluate whether SWEMWBS detected statistically important changes at the group level. Cohen’s D effect size (ES) and Standard error of measurement (SEM) and were used to evaluate whether SWEMWBS detected statistically important changes at the individual level.ResultsMean (SD) SWEMWBS scores increased from baseline to therapy 4 from 19.28 (3.921) to 23.32 (4.873). At group level, using Cohen’s D effect size, improvement ranges from ES = 0.20–1.41 and using SRM, ranged from 0.30–0.88, increasing with number of therapy sessions. (P^) ranged from 0.65–0.8. At individual level, use of Cohens D ES > 0.5 indicated statistically important improvement in 29.9–86.1% cf. 20.1–80.6% using a standard of 2.77 SEM (2.87 points). The lower threshold of 1 SEM (1.03 points) indicated statistically important improvement in 43.0–81.0%.ConclusionSWEMWBS is responsive to change at individual and group level. At individual level a change of between 1 and 3 points meets thresholds for statisticially important change, depending on standard used. Anchor based studies are necessary to confirm that such change represents minimally important change from the perspective of study participants.

Purpose This study assesses the construct validity and sensitivity to change of the Short Warwick-Edinburgh Mental Well-being Scale (SWEMWBS) as an outcome measure in the treatment of common mental disorders (CMD) in primary care settings. Methods 127 participants attending up to 5 sessions of therapy for CMD in primary care self-rated the SWEMWBS, the Patient Health Questionnaire (PHQ-9) and General Anxiety Disorder (GAD-7) scales. SWEMWBS’s construct validity and sensitivity to change was evaluated against the PHQ-9 and GAD-7 across multiple time points in two ways: correlation coefficients were calculated between the measures at each time point; and sensitivity to change over time was assessed using repeated measures ANOVA. Results Score distributions on SWEMWBS, but not PHQ-9 and GAD-7, met criteria for normality. At baseline, 92.9% (118/127) of participants scored above clinical threshold on either PHQ-9 or GAD-7. Correlations between SWEMWBS and PHQ-9 scores were calculated at each respective time point and ranged from 0.601 to 0.793. Correlations between SWEMWBS and GAD-7 scores were calculated similarly and ranged from 0.630 to 0.743. Significant improvements were seen on all three scales over time. Changes in PHQ-9 and GAD-7 were curvilinear with greatest improvement between sessions 1 and 2. Change in SWEMWBS was linear over the five sessions. Conclusions This exploratory study suggests that SWEMWBS is acceptable as a CMD outcome measure in primary care settings, both in terms of construct validity and sensitivity to change. Given patient preference for positively over negatively framed measures and statistical advantages of measures which are normally distributed, SWEMWBS could be used as an alternative to PHQ-9 and GAD-7 in monitoring and evaluating CMD treatment.

Evaluation of a universal, mental wellbeing and mindfulness programme in a UK graduate entry medical school DesignMixed methods: measurement of mental wellbeing and mindfulness in 2 cohorts at 3 time points over 15mths; descriptive, regression and repeated measures analysis with post hoc pairwise comparisons; qualitative interviews with purposive sample of 13 students after 1yr analysed thematically; spontaneous anonymous feedback on the course. FindingsThe course was a surprise to students, and reactions mixed. Respect for its contents grew over the first year. Most students had actively implemented a wellbeing strategy by the end of the course and an estimated quarter were practicing some mindful activity.In the context of an overall decline in wellbeing and limited engagement with mindfulness practice, increases in mindfulness were protective against this decline in both cohorts (p<001).A small minority of students thought the course was a waste of time. Their attitudes influenced engagement by their peers. The mindfulness and wellbeing practices of the facilitators were evident to students and influenced perceived effects. Research LimitationsThe uncontrolled nature of this observational study and low response rates to the survey limit conclusions. Further research in other medical education settings is needed. Practice ImplicationsResults are encouraging, suggesting modest benefit in terms of changing attitudes and practices and a modest protective effect on the wellbeing of students who engaged. Originality/valueThis is the first study of a universal wellbeing and mindfulness programme in a UK medical school. Universal programmes are rare and evaluation studies are scarce.

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